Share article

Optimal adjuvant therapy for endometrial carcinoma has not been clearly defined. Radiation therapy is generally used for earlier stages, while more advanced disease is generally treated with chemotherapy.

Subgroup analysis of stage II and IIIa (positive cytology) patients showed an OS and PFS benefit to chemotherapy over WPR.

Clinical/Scientific Implications

In this trial, a very heterogeneous group of patients was treated with a standardized technique. Radiation and/or chemotherapy technique was not customized for patient stage and known risk factors as has become common practice. However, the overall result of the trial, showing no difference between WPR and chemotherapy for intermediate risk disease, is the first randomized phase III evidence that chemotherapy alone may be adequate adjuvant treatment, without WPR, in this group of patients. Because of the limitations of the study, it should be considered hypothesis-generating, rather than as defining a new standard of care. Further study of risk factors for local vs distant recurrence and pattern of failure is sorely needed and will help us to custom tailor adjuvant treatment regimes to meet each patient's needs.

The unplanned subgroup analyses may indeed support the hypothesis that more advanced and high risk endometrial cancer patients benefit from chemotherapy because of the high risk of metastatic disease. Whether or not high-intermediate risk patients benefit from the local control benefit of radiation cannot be discerned from this trial. Results from unplanned subgroup analysis must be taken with a grain of salt.

Mar 8, 2010 - In patients with high-intermediate-risk endometrial cancer, vaginal brachytherapy is just as effective as pelvic external beam radiotherapy for prevention of vaginal recurrence, has fewer toxic effects and leads to improved quality of life, according to a study in the March 6 issue of The Lancet.